Kidney Week

Abstract: TH-PO1073

Opiate and Non-Opiate Analgesic Use and Mortality Among CKD Patients Transitioning to Dialysis

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• You, Amy Seung, University of California, Irvine, Orange, California, United States

Amy Seung You,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Elani Streja,

• Ravel, Vanessa A., Harold Simmons Center, University of California at Irvine, Orange, California, United States

Vanessa A. Ravel,

• Sim, John J., Kaiser Permanente Southern California, Los Angeles, California, United States

John J. Sim,

• Obi, Yoshitsugu, University of California, Irvine, Orange, California, United States

Yoshitsugu Obi,

• Nguyen, Danh V., University of California, Irvine, Orange, California, United States

Danh V. Nguyen,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Rhee, Connie, University of California Irvine, Huntington Beach, California, United States

Connie Rhee,

Background

Population based studies show there is a high prevalence of chronic kidney disease (CKD) patients suffering from chronic pain. While opiates are frequently prescribed as analgesics, there may be toxic accumulation of metabolites, particularly among those with non-dialysis dependent CKD (NDD-CKD) progressing to end-stage renal disease (ESRD). We thus sought to examine the association of opiate vs. non-opiate analgesic use during the pre-ESRD (prelude) period with post-ESRD mortality risk among NDD-CKD patients transitioning to dialysis.

Methods

We examined a national cohort of US veterans with NDD-CKD who transitioned to dialysis over 2007-14. Among patients who had receipt of prescriptions in the Veterans Affairs (VA) Healthcare System within one year of transitioning to dialysis, we examined the association of pre-ESRD analgesic use (opiate analgesic, non-opiate analgesic, vs. no analgesic use) with post-ESRD all-cause mortality risk using adjusted Cox models.

Results

Among 57,764 patients who met eligibility criteria, pre-ESRD opiate use was associated with higher post-ESRD mortality risk (ref: no analgesic use), whereas non-opiate analgesic use was not associated with higher death risk in expanded case-mix adjusted analyses: HRs (95%CIs) 1.11 (1.08-1.13) and 1.01 (0.98-1.04), respectively. In sensitivity analyses, increasing frequency of opiate prescription in the one-year prelude period was associated with higher post-ESRD mortality risk: (ref: no analgesic use): HRs (95%CIs) 0.99 (0.95-1.02), 1.12 (1.06-1.18), 1.15 (1.07-1.23), 1.20 (1.10-1.31), and 1.31 (1.25-1.37) for 1, 2, 3, 4, and ≥5 prescriptions, respectively.

Conclusion

In NDD-CKD patients transitioning to dialysis, more frequent pre-ESRD opiate use was associated with higher post-ESRD death risk, whereas non-opiate analgesic use was not associated with higher mortality. Further studies are needed to identify non-opiate based interventions for pain management in this population.

Funding

• NIDDK Support